Providers of healthcare services, such as clinicians, prescribe or recommend various orderables to treat ailments or conditions diagnosed in patients. Examples of categories of orderables include substance-based agents (such as medications or other chemical agents), medical equipment, supplies, laboratory tests, or medical services. Increasingly, clinicians are utilizing electronic order management systems to enter and manage orderables for their patients. One example of such an electronic order management system is the POWERORDERS application available from Cerner Corporation of North Kansas City, Mo. For instance, using such an order management system, a physician or other clinician wishing to prescribe a medication for a particular patient may access a profile for the patient and initiate an order for the medication, entering details for the medication order. After initiating the order, the physician may “sign” the order, indicating to the order management system to process the order. Once the order has been processing in the order management system, it is electronically dispersed to the appropriate location, such as a pharmacy. In addition, the order is maintained in the profile, which allows other clinicians to view the order as well as other orders that have been placed for the patient.
Orders for substance-based orderables may be created by a clinician for administration of the medication or chemical agent to a patient on an “as needed” or P.R.N. basis, or alternatively, on a scheduled basis. As illustrative examples of scheduled orderables, a physician may prescribe an antibiotic to be taken once or twice a day for a certain number of days to treat an infection, or a chemotherapy agent to be taken over a period of time to kill cancerous cells. One difficulty with scheduled orderables is how to compensate when a dose is not administered at the time scheduled. A clinician may have created a B.I.D. order schedule (twice-a-day administration) so that a medication is received, for instance, around the time a hospitalized patient eats their morning and evening meals. If another clinician or aide fails to administer the medication dose at the scheduled time (or administers the medication too soon), future scheduled administration times may need to be altered to ensure the patient receives the therapeutic effect from the medication that was intended by the prescribing clinician.
However, with certain medications or chemical agents, and sometimes dependant upon the conditions they are intended to treat, altering an administration schedule for these substance-based orderables can have significant negative consequences for the patient. For instance, if a scheduled administration of a chemotherapy agent is missed, or a patient must alter the time of the day they normally receive a chemotherapy dose, it may or may not be prudent (e.g., according to a standard of care protocol) to administer the dose immediately when it is noticed that the scheduled time has passed or a new scheduled time has arisen. Additionally, these changes may alter the total length of time for the order, which may be undesirable if the substance-based orderable (such as a chemotherapy agent) is only supposed to be present within the patient's body for a set period of time.
The difficulty in altering administration schedules for substance-based orders is further complicated since a scheduling for an order may be altered in a number of ways, only some of which present a strong opportunity for maintaining the originally intended therapeutic effect for the patient. It can be difficult for clinicians to consider all of the scheduling options simultaneously. Specifically, it is difficult to easily comprehend how the schedule for administration of orderables compares across the revised scheduling options, and what particular variations from the originally intended administration schedule result if a particular revised scheduling option is selected.